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Michael E. Greer, M.D. Holistic, Homeopathic, Herbal & Natural Solutions for Health Webinar Sampler Trekking Series 12-hour Seminar 737 Olive Way, Suite 1804, Seattle, WA 98101 www.michaelgreermd.com [email protected] About Dr. Greer • OB-GYN by training • Board certified in 1984 • Alternative medicine in my practice since 1996 • Combining the best of integrative medicine for optimal patient wellness 2 Webinar Contents • Trekking the Hormone Jungle • Adrenal Fatigue: Etiology, Diagnosis & Nutritional Solutions • Detoxifying in a Toxic World • Diabetes: Overview & Treatment Options • Estrogen Dominance & Its Role in Cortisol, Weight Management & Hypothyroidism • Testing for Wellness: How to Test & Interpret Results for Maximum Wellness 3 Understanding how all the hormones influence each other to attain hormone balance Parotid Gland Initiates the Hormones Ghrelin & Leptin • GHRELIN: The “I am Hungry” hormone released in the stomach and intestine • LEPTIN: The “I am Full” hormone that helps control fat storage and appetite – Fat cells produce and secrete leptin Ghrelin and leptin work together as a regulatory arm in the feedback communication of hunger Ghrelin Leptin 5 Leptin & Heart Disease • Obesity and cardiovascular disease are closely related – Leptin, an adipocyte-produced hormone, is associated with increased cardiovascular risk – Increased plasma levels of leptin are measurable in the plasma of obese individuals • An Italian study associating Leptin & CV disease found a close relationship between Leptin and CRP – Provides support to the view that this adipokine, besides being involved in the pathobiology of obesity, might play an active role inflammation and atherothrombosis Dr Rosa S, Cirillo P et al, J Vasc Res, Jun 2009;46(6):609-619 6 Function of Leptin • Produced by fat cells, leptin signals the hypothalamus that we have consumed enough calories and can stop eating – Suppresses appetite • Increases triglyceride breakdown in adipocytes • As excess glucose accumulates in the blood (pre diabetes segue), the glucose is converted by glycerol3-phosphate dehydrogenase (an enzyme) into triglycerides for storage into adipocytes 7 Leptin Resistance • As we age, our cells become leptin resistant – Similar to insulin resistance – C-reactive protein (CRP) – the most accurate marker of systemic inflammation - binds leptin and prevents it from crossing the blood-brain barrier to signal satiety • Proof that systemic inflammation and detoxification failure plays a very powerful role in weight regulation 8 CRP & IL-6 Predict Death • Elevated CRP, IL-6 (and other inflammatory cytokines) indicate significantly greater risks of contracting or dying from many diseases – Heart attack, stroke, Alzheimer’s disease, etc. • In a study of a group from the Women’s Health Study, several risk factors predicted Type II diabetes – Baseline levels of CRP and IL-6 were significantly higher among those who later developed diabetes – Supports a possible role for inflammation in diabetogenesis Prandhan et all, JAMA, July 18, 2001 9 The Extra-cellular Matrix • Fat cells store toxic waste. Estrogen is made from fat cells. Fat breakdown is inflammatory! 10 Detoxification & Drainage • Toxic waste is deposited into the cellular matrix for disposal – Must be diluted by the addition of water to prepare them for elimination – Explains why we have to urinate the first thing in the morning (or during the night) • Fat cells STORE TOXIC WASTE – Protect the rest of the body from involvement in detoxification until the time is right 11 Cardiac-CRP and Cancer • “Elevated levels of Cardiac-CRP in cancer-free individuals are associated with increased risk of cancer of any type ... (and) with early death after a diagnosis of cancer.” • Regular monitoring of Cardiac-CRP is an important component of a health maintenance program Circulation.2008 Nov 25;118(22):2243-51 12 Chronic Toxins and Inflammation Exposure Systemic Effects Signs & Symptoms Disorders • Nervous system • Endocrine system (hormones) • Immune system • Sensitivity to chemicals, odors, medications, etc. • Chronic fatigue • Depression, anxiety, mood swings • Cognitive dysfunction • Recurrent headaches • Muscle aches and weakness • Infertility • Recurrent infections • Autoimmune disease • Reproductive disorders • Chronic dermatitis • Neurodegenerative disorders • Autism • Obesity – Allergies – Autoimmune – Chronic infections 13 CRP and Dementia Risk • Appears to correlate with nutrition-related diseases – Cardiovascular, metabolic, obesity, etc. • In fact, patients who are obese at middle age are almost twice as likely to develop dementia later in life (check CRP!) • Elevated cholesterol and serum cardiac homocysteine levels also appear to be independent risk factors for cognitive decline 14 Other Hormones Involved in Appetite Regulation • INSULIN - Increases ghrelin (thus hunger), cortisol, norepinephrine • CORTISOL - Increases insulin, decreases thyroid function by blocking T4 to T3 conversion – Active mechanism = liver produces 3-4X more TBG (thyroid binding globulin) a SHBG (sex hormone binding globulin) to decrease thyroid function • SEROTONIN - Increases leptin (thus a “full” sensation, decreasing hunger) 15 Testosterone Androstenedione Estradiol-17 (E2) Estrone (E1) Estriol (E3) Cortisol Upregulates E1 & High Estrogen Upregulates Cortisol High Estrogen Increases T4-Binding Globulin (TBG) 2-3X Lower Thyroid Hormone Activity Suppresses Metabolism Lower Metabolism Leads to Weight Gain 16 10 Essentials to Keep the Weight Off and Decrease Inflammation 1. 2. 3. 4. Improve Digestion Minimize Cortisol Lower Insulin Level Eliminate Excess Estrogen 5. Treat Sub-clinical Hypothyroidism 6. Support the Adrenal Glands 7. Eat Healthy and in Moderation 8. Exercise 9. Kill the Inflammation 10. Sleep 17 Essential Fatty Acids Initiate the Hormone Sequence • Fish Oil – Principally Omega-3 – The most highly unsaturated fatty acid, easily oxidized in light, air, heat • Flax Oil – Principally Omega-6 – Converts to Omega-3 Essential fatty acids: linolenic, arachidonic, omega-3s and derivatives, etc.` 18 Systemic support: Comparing Omega-6 & Omega-3 19 Misc Benefits Of Omega-3 • Possibly reducing the risk of many other medical conditions – Painful periods – Diabetic kidney damage – Obesity – Skin conditions – Some cancers – Crohn's disease – May improve pulmonary function 20 Anti-Inflammatory Products • SP Cataplex F (3-9 tabs/day, 3-6 perles/day) – Flax seed with 0.8 mg B6 – Tabs contain 95mcg iodine – Perles contain no iodine • SP Linum B6 (3-6 perles/day) – Flax seed oil (630 mg) and B6 • SP Black Currant Seed Oil 320 mg (3-6p/day) – Omega-6 GLA -47mg • SP Wheat Germ Oil 385 mg /Fortified • Cataplex E 50 IU (3-6 p/day) 21 Anti-Inflammatory Products • SP Chlorophyll Complex perles™ – Vit A 335 IU (3-9 p/day) • SP Calamari Omega-3 Liquid – DHA 800mg/EPA 400mg SP (1 tsp/day) • SP Tuna Omega-3 – DHA 300mg/EPA 60 mg with Tuna Oil 1,200 mg 22 E1, E2 & E3 • The three most widely known estrogens: – Estrone (E1) – Estradiol (E2) – Estriol (E3) • Estradiol and estrone interconvert freely, and both may be metabolized to 2-hydroxylated, 16-hydroxylated, or other forms – These hydroxylation steps take place in various tissues, including breast, kidney, and liver 23 Estrone vs. Estradiol • An imbalance occurs between the types of estrogens – Although estradiol levels decline, estrone levels decline much more slowly, resulting in more estrone than estradiol • Although both hormones are strong enough to cause concern about the development of breast cancer, the ratio of the hydroxyestrones becomes a more significant factor 24 Estrogen Differences • Some hydroxyestrones (4-hydroxy- and 16alpha-hydroxyestrone) may promote cancer, while 2-hydroxyestrone seems to prevent it • Estrone is less desirable because it is cancerpromoting and tends to be naturally present in higher quantities relative to the other two estrogens during menopause 25 Indole-3-carbinol (I3C) • I3C is one of several potent compounds found in cruciferous vegetables such as broccoli, cauliflower, and Brussels sprouts • I3C functions by modulation of hormones and the activation of genes • Dosage should be based on weight – 179 lbs: 200 mg – 80-239 lbs: 300 mg – Over 239 lbs: 400 mg 27 Cruciferous Complete • Contains Kale (300 mg), Brussels sprouts (300mg) • Essential to modulate E-2 flow for Estrogen metabolities • E-2 is anti cancer • E-2 is anti-inflammatory Common Symptoms of Excess Estrogen • • • • • • • • • • • Water retention Breast swelling & tenderness Craving for sweets Fibrocystic breasts Uterine fibroids Nervousness/anxiety/irritability Heavy, irregular menses Fatigue Weight gain Mood swings Low thyroid symptoms 29 Thyroid & Dieting • Thyroid levels fluctuate in response to caloric intake, exterior temperature, etc. – During starvation (diet) the body naturally lowers thyroid hormone – Lower metabolism results in more estrogen and fat storage • Estrogen and thyroid hormone have opposite effects – Estrogen causes calories to be turned into fat – Thyroid hormone initiates fat conversion to energy 30 Thyroid Hormone Exists in 2 Major Forms T4 + T3 Think of T4 as firewood and T3 as fire T4 T3 Tri-iodothyronine (T3) is 8 times more biologically active than T4 31 Wellness Testing for Adrenal Fatigue ©2011, Michael Greer, MD. May not be reproduced without permission. 32 Adrenal Rhythm & Its Importance • The human adrenal gland does not secrete its steroid hormones at a constant level throughout the day • The hormones are released in a cycle – Highest value in the morning – Lowest at night • 24-hour cycle: circadian rhythm 33 Thyroid Function • Intracellular cortisol controls thyroid hormone production • Hypothyroid symptoms such as fatigue and low body temperature may be due to an adrenal maladaptation 34 Constant Stimulation • Constant cortisol stimulation allows adrenal (cortisol) stimulation for emergencies • Followed by tolerance • Followed by depletion of adrenal gland hormones when over stimulated 35 Adrenal Fatigue Symptoms • • • • • • Fatigue Chronic illness Decreased sex drive Panic attacks Mild depression PMS • • • • • • Stubborn belly fat Absentmindedness Irritability Unclear thinking Asthma Hair loss and more 36 Defining Stress • Much of the investigation into the effects of stress was carried out by Hans Selye • Developed a theory called the General Adaptation Syndrome (GAS) – Hypothesized that stress is a major cause of disease • Believed that chronic stress causes long term chemical changes within the body and the body’s ability to copy with stress is an exhaustible resource 37 Cortisol: Clinical Manifestations Target Tissue GC Excess or Hypersensitivity GC Deficiency or Resistance CNS Insomnia, anxiety Depression, fatigue, malaise, defective cognition Liver ↑ gluconeogenesis and lipogenesis Hypoglycemia Fat ↑ visceral fat, metabolic syndrome Weight loss Cardiovascular Hypertension Hypotension Bone Osteoporosis, stunted growth Immunity/inflammation Immune suppression, vulnerability to infection and tumors Chrousos GP, Kino T. Stress 2007; 10(2): 213-219 ↑ inflammation, autoimmunity and allergy 38 Stress and the Thyroid By conservative estimates, 50% of the individuals diagnosed with hypothyroidism also have adrenal fatigue or depletion Rothfield GL, Romaine DS. Thyroid Balance, Adams Media, Avon, 2003, p.97. 39 Stress and Immunity • One of the key discoveries of the research by Selye was stress-induced immune suppression • GCs impact T-cells more than B-cells – Thus cell-mediated immunity is more disrupted than antibody-mediated immunity – Results in less protection against pathogens Bornstein SR, Rutkowski H. Endocrine Res 2002; 28(4): 719-728 40 Stress and Immunity • There is a transient immune stimulation in response to stress regardless of cause • It is chronic stress that causes the issues described and the increased risk of infections Sapolsky, RM. Why Zebras Don’t Get Ulcers, 3rd Ed, Henry Holt and Co, New York, 2005, p. 155 41 Stress and Autoimmunity • With chronic stress the immune system is being constantly ramped up • Over time this is associated with an increased risk of autoimmune diseases Sapolsky, RM. Why Zebras Don’t Get Ulcers, 3rd Ed, Henry Holt and Co, New York, 2005, p. 155 42 How Adaptogens Work • Exact mode of action of adaptogens is unclear and many possibilities have been put forward • Possible that different adaptogenic herbs may have different modes of action 43 On/Off • Adaptogens have the ability to influence the ‘switch on’ and ‘switch off’ systems 44 Herbs With Adaptogenic Activity • Chinese/Korean ginseng (Panax ginseng) (1/2 tsp 1-2x/day) • Astragalus (Astragalus membranaceus) 1-2 day (tab or liquid) • Siberian ginseng (Eleutherococcus senticosus) (tab or liquid 1-2x/day) • Withania (Withania somnifera) (tab or liquid 12x/day) 45 Withania Complex • • • • Skullcap Herb 4:1 extract (117.5 mg) Licorice Root 7:1 extract (107.15mg) Withania (Ashwaganda)root 10:1 extract (95mg) Korean Ginseng root 5:1 extract (20 mg) 46 Foods That Hurt the Adrenals • Coffee and black tea (including decaf) - elevate cortisol • Juice - high glycemic index – incites insulin • Sugar - high glycemic index – incites insulin • Alcoholic beverages - stuns the liver • Deep-fried foods - saturated fats • Rancid oils, seed and nuts - increase need for antioxidants for the free radicals • Soda, including diet soda - elevates insulin, cortisol • Processed meats and cheeses – sulfites, which impair detox by the liver 47 This Webinar is a Sampler Only Attend the Seminar for immediately applicable information 48 Michael E. Greer, M.D. Holistic, Homeopathic & Herbal Solutions for Health 2721 First Avenue, Suite 408, Seattle, WA 98121 Tele: (206) 343-5985 Fax: (206) 343 2356 www.michaelgreermd.com [email protected] 49